<p>On August 20, 1998, at three o’clock in the afternoon, Michael Fisher (not his real name), a 12 year old boy, was brought into the A&amp;E Department with a severe head injury. He was a pedestrian who had been knocked down by a car. A rapid initial assessment revealed the following; his airway was patent, an oropharyngeal airway was in place. He was breathing although respirations were depressed. He had a cardiac output but pulse was weak and rapid, blood pressure was low and he was losing blood from a large wound in the back of his head. He was also, unresponsive; his Glasgow coma score was only five. Vital information obtained from the paramedic crew informed us that the child had been unconscious when they arrived at the scene, and that matter consistent with brain tissue was discovered at the roadside.</p>